Selection of treatment modalities in children with spastic cerebral palsy

Paul Steinbok B.Sc., M.B.B.S., F.R.C.S.(C)
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  • Division of Pediatric Neurosurgery, Department of Surgery, British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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✓ The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.

Abbreviations used in this paper:ADL = activities of daily living; CP = cerebral palsy; GABA = γ-aminobutyric acid; GMFM = Gross Motor Function Measure; ITB = intrathecal baclofen; RCT = randomized controlled trial; SDR = selective dorsal rhizotomy; SPN = selective peripheral neurotomy.

✓ The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.

Abbreviations used in this paper:ADL = activities of daily living; CP = cerebral palsy; GABA = γ-aminobutyric acid; GMFM = Gross Motor Function Measure; ITB = intrathecal baclofen; RCT = randomized controlled trial; SDR = selective dorsal rhizotomy; SPN = selective peripheral neurotomy.

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Contributor Notes

Address reprint requests to: Paul Steinbok, M.B.B.S, Division of Pediatric Neurosurgery, 4480 Oak Street, #K3–159, Vancouver, British Columbia, Canada V6H 3V4. email: psteinbok@cw.bc.ca.

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